腹腔镜子宫切除术中舒芬太尼联合丙泊酚持续输注最佳剂量探讨

目的探讨腹腔镜下子宫切除术舒芬太尼伍丙泊酚时持续输注舒芬太尼最佳剂量。方法拟行腹腔镜子宫切除术90例,ASAⅠ^Ⅱ级。随机分为三组(S1、S2、S3),每组30例。采用持续输注舒芬太尼和丙泊酚5 mg/kg·h维持麻醉,S1组、S2组、S3组分别输注舒芬太尼0.2、0.4、0.6μg/kg·h。术中平均动脉压(MAP)大于基础值15%或心率(HR)大于基础值20次/min,静脉注射10μg舒芬太尼。记录舒芬太尼使用情况;诱导前(T0)、诱导后(T1)、插管后(T2)、术中(T3)、术毕时(T4)、拔管后(T5)MAP和HR;自主呼吸恢复时间、清醒时间、出现疼痛时间;术中知晓,苏醒时躁动、恶心/呕吐、疼痛及术后肌肉注射曲马朵情况。结果①S3组舒芬太尼量高于S2组与S1组;S3组静脉注射10μg舒芬太尼例数少于S2组和S1组,S2组少于S1组(P<0.05);②各组同时点MAP和HR差异无统计学意义(P>0.05);组内比较,各组T1时点MAP和HR均低于T0及其他时点(P<0.05);③S3组自主呼吸恢复时间、苏醒时间及出现疼痛时间长于S1组与S2组(P<0.05);S3组苏醒时疼痛和术后肌肉注射曲马朵发生率低于S1组和S2组(P<0.05)。结论腹腔镜子宫切除术伍丙泊酚时持续输注舒芬太尼最佳剂量为0.6μg/kg·h。

Optimal dose of sufentanil by continuous infusion when companied with propofol in laparoscopic hysterectomy

Objective To investigate optimal dose of sufentanil by continuous infusion when companied with propofol in laparoscopic hysterectomy. Methods The 90 ASAⅠ-Ⅱpatients undergoing laparoscopic hysterectomy were randomly divided into 3 groups （n=30）： S1 group,S2 group and S3 group. Anesthesia was maintained with sufentanil and propofol 5 mg/kg·h by continuous infusion; S1 group,S2 group,and S3 group received respectively sufentanil 0.2,0.4 and 0.6 mg/kg·h. Additional sufentanil boluses（10μg） were given to patients in all groups when there was an increase in heart rate （HR） by more than 20 beats per minute or mean arterial pressure （MAP） by more than 15% above baseline. The consumption of sufentanil were recorded; MAP and HR before and after induction （T0 and T1）,after intubation （T2）,intraoperative period （T3）,at the end of surgery （T4） and after extubation （T5） were recorded; Times to spontaneous ventilation,recovery and pain were record; the incidences of awareness in the intraoperative period,dysphoria,nausea and vomiting,pain in recovery period and the consumption of Tramadol were record. Results 1）Total sufentanil consumption in S3 group was more than in S1 and S2 group （P〈0.05）; The bolus of 10μg sufentanil requirement in S3 group was less than in S2 and S1 group （P〈0.05）. 2）There were no statistically difference in MAP and HR at the same time in three groups （P〉0.05）; MAP and HR at T1 time in three groups were less than at other different time（P〈0.05）. 3）The time of spontaneous ventilation,recovery and pain in S3 group were longer than in S1 and S2 group （P〈0.05）. 4）There were no incidence of awareness in the intraoperative period in three groups;There were no statistically difference in incidences of dysphoria,nausea and vomiting in recovery period （P〉0.05）;The incidence of pain and consumption of Tramadol in S3 group was lower than in S1 and S2 groups after recovery. Conclusion Optimal dose of sufentanil by continuous inf